Perioperative cardiovascular mortality in noncardiac surgery: Validation of the Lee cardiac risk index

Boersma, Eric; Kertai, Miklós D.; Schouten, Olaf; Bax, Jeroen J.; Noordzij, Peter G.; Steyerberg, Ewout W.; Schinkel, Arend F. L.; Santen, Marian van; Simoons, Maarten L.; Thomson, Ian R.; Klein, Jan; Urk, Hero van; Poldermans, Don

doi:10.1016/j.amjmed.2005.01.064

Cited by 320 publications

(204 citation statements)

References 23 publications

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“…12 Wijeysundera has reported on a large cohort of non-cardiac surgical patients in Ontario, 14 and in a subsequent analysis, found virtually the same unadjusted odds ratio (OR) for male mortality (OR, 1.49; 95% CI, 1.39 to 1.61) that we report here (personal communication). Although this data included patients from our hospital, only one year of the ten-year period covered by this study overlapped with ours.…”

Section: Discussionsupporting

confidence: 81%

“…11 In a ten-year series, Boersma et al examined mortality differences between males and females across all categories of non-cardiac surgery, and in 2005, they reported an increased risk of male mortality (2.2% in males vs 1.3% in females). 12 Although this study was a validation of the Lee cardiac risk index, Boersma did not analyze the preoperative risk factors by sex.…”

Section: Résumémentioning

confidence: 98%

See 1 more Smart Citation

Gender differences in mortality following non-cardiovascular surgery: an observational study

Grewal

Wijeysundera

Carroll

et al. 2011

Can J Anesth/J Can Anesth

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Section: Discussionsupporting

confidence: 81%

Section: Résumémentioning

confidence: 98%

Gender differences in mortality following non-cardiovascular surgery: an observational study

Grewal

Wijeysundera

Carroll

et al. 2011

Can J Anesth/J Can Anesth

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“…Noncardiac surgery is associated with major cardiovascular complications 1 and a cardiac event mortality rate of 1%. 2 Therefore, perioperative cardiovascular morbidity and mortality are targets for study and practice improvement. Many studies have associated postoperative myocardial ischemia with adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Beta Blockade

Irani

2013

Clinics in Colon and Rectal Surgery

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The use of preoperative beta (?) blockade has been through several changes, and it is clear that large, randomized controlled trials on the subject are in need. Currently, a judicious approach to perioperative ? blockade is supported. Continuation of ? blockers is recommended for the patient taking them prior to surgery. Patients undergoing large colorectal procedures, with coronary artery disease or high cardiac risk, should have ? blockers titrated to heart rate and blood pressure. Dosages should be titrated to heart rate and blood pressure rather than using fixed, long-acting dosages. When ? blockers are indicated, they should be initiated weeks before surgery.

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“…Boersma et al 6 reviewed the records of 108,593 patients undergoing noncardiac surgery at Erasmus University database from 1991-2000 and found that RCRI was a good predictive tool and the * Corresponding author.…”

mentioning

confidence: 99%

Revised cardiac risk index—a simple universal tool for peri-operative risk prediction

Deshpande¹

2012

Indian Heart Journal

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Patients subjected to non-cardiac surgery are at a significant risk to develop cardiac complications. With aging populations and improved surgical and anaesthesia techniques, even elderly populations are frequently considered for non-cardiac surgery today. It is estimated that about 40 million non-cardiac surgeries are performed in Europe annually and the perioperative myocardial infarction (MI) occurs at a rate of 1% causing 400,000 myocardial infarcts. Further, the cardiovascular mortality rate of 0.3% gives mortality of 133,000 annually related to non-cardiac surgery. 1 It is also a well-known fact that the peri-operative complications are more frequent following vascular surgery. 2 Number of risk assessment algorithms have been developed and tested, however the revised cardiac risk index (RCRI) 3 described by Lee et al. in 1999, remains the most used risk assessment model. These indices are predominantly based on history and simple clinical tools. Patients with active cardiac conditions like, unstable angina or severe angina, recent MI (within 30 days), significant arrhythmias (advanced heart blocks, atrial fibrillation with uncontrolled ventricular rate, symptomatic ventricular arrhythmias, and symptomatic bradycardia), and severe valvular disease undergoing planned non-cardiac surgery, need to be evaluated extensively, and at times, this may lead to postponement or cancellation of the planned surgery. 4 Patients with risk factors as indicated by the risk scores but without active cardiac conditions need to be evaluated further to prevent postoperative cardiovascular events. A pooled analysis of several studies found a 30-day incidence of cardiac events (postoperative MI and death) of 2.5% in unselected patients >40 years of age. 2 Incidence of postoperative cardiac events varies widely depending upon the tools used to detect myocardial damage as the events may occur silently. Use of sensitive markers like troponins, can detect largely asymptomatic cardiac events. 1 Such patients have higher 6-months event rates as compared to those who do not show elevation of troponins following non-cardiac surgery. Risk assessment prior to planned noncardiac surgery can help in predicting the postoperative events. It also helps the physician and anaesthesiologist to take necessary precautions to minimise the postoperative events.In this issue of the journal Jayakeerthi et al. 5 have reported their experience of pre-operative risk evaluation on 920 patients referred for cardiac assessment. They used RCRI proposed by Lee et al. in 1999 3 for prediction of cardiac events following surgery in 853 patients. The RCRI was described for planned non-cardiac surgery patients, whereas, the cohort described in the current report includes emergent surgical procedures in addition to elective surgeries, which the authors believe reflects the real world. The number of emergency surgeries was relatively small (40/853). Electrocardiogram (ECG) monitoring was done for all patients (pre-operative, immediate postoperative and 1st postoperat...

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Perioperative cardiovascular mortality in noncardiac surgery: Validation of the Lee cardiac risk index

Cited by 320 publications

References 23 publications

Gender differences in mortality following non-cardiovascular surgery: an observational study

Gender differences in mortality following non-cardiovascular surgery: an observational study

Perioperative Beta Blockade

Revised cardiac risk index—a simple universal tool for peri-operative risk prediction

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